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Rumination Syndrome May Be Underrecognized in Children With Eosinophilic Esophagitis

Rumination Syndrome May Be Underrecognized in Children With Eosinophilic Esophagitis 1024 683 Madison Storm
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New research highlights the importance of considering co-diagnoses in children with persistent regurgitation.

Regurgitation is a common symptom in both eosinophilic esophagitis (EoE) and rumination syndrome (RS), but new research suggests the overlap between the two conditions may be greater than previously recognized. The findings highlight a potential diagnostic challenge for pediatric gastroenterologists and underscore the importance of considering both conditions when symptoms persist despite treatment.

EoE is a chronic inflammatory disease characterized by eosinophilic infiltration and symptoms including dysphagia, food impaction, abdominal pain, vomiting and feeding difficulties. RS, a disorder of gut-brain interaction, is characterized by the repetitive, effortless regurgitation of recently ingested food, typically occurring soon after meals. While the conditions can present with similar symptoms, little research has explored how often they occur together or how one diagnosis may affect recognition of the other.

In a study published in the Journal of Pediatric Gastroenterology and Nutrition, researchers examined the prevalence of EoE among children with RS and characterized the clinical course of patients diagnosed with both conditions. Among 230 children with RS evaluated between 2016 and 2023, 22 also had EoE, representing a higher prevalence of approximately 10%, substantially higher than the estimated 0.1% prevalence of EoE in the general pediatric population.

Delayed Diagnosis Despite Characteristic Symptoms

Most patients with both diagnoses were male adolescents, and the majority were diagnosed with EoE before RS. Although 91% initially presented with regurgitation, patients who received an EoE diagnosis first experienced a median delay of more than 15 months before being diagnosed with RS.

“We noted many children in clinic with rumination syndrome who also had a diagnosis of eosinophilic esophagitis, more than what felt like coincidence,” says Dennis Yang, MD, medical resident at Nationwide Children’s. “Rumination syndrome is characterized by repetitive, effortless, post-prandial regurgitation, while EoE is an organic disease defined by biopsy findings. We wanted to better understand the relationship between the two conditions.”

The delay is notable because previous research has linked delayed intervention for RS with poorer outcomes and reduced responsiveness to treatment. The authors say these findings suggest RS may be underrecognized in pediatric patients presenting with regurgitation, particularly when endoscopic and histologic features of EoE are also present. They note that careful clinical history-taking may help identify RS earlier, as a detailed symptom history can often reveal the characteristic features of the disorder.

Looking Beyond Esophageal Inflammation

The study found that standard EoE treatments successfully improved esophageal inflammation in many patients. However, regurgitation often persisted even after EoE remission was achieved.

In contrast, nearly two-thirds of patients experienced improvement or resolution of regurgitation after receiving RS-directed treatment, including behavioral therapies such as diaphragmatic breathing and biofeedback, as well as baclofen, a medication sometimes used to help reduce episodes of rumination and regurgitation.

“Most patients were diagnosed with eosinophilic esophagitis first despite presenting primarily with regurgitation,” says Dr. Yang. “We found that many continued to experience regurgitation despite treatment for EoE, while a majority improved after receiving therapies directed at rumination syndrome. These findings reinforce the importance of considering both diagnoses during evaluation.”

Implications for Clinical Care

These findings suggest persistent regurgitation should not automatically be attributed to ongoing EoE activity. Instead, clinicians may need to consider a parallel diagnostic approach when features of both conditions are present.

“For children with eosinophilic esophagitis who continue to experience regurgitation despite appropriate treatment, clinicians should consider whether rumination syndrome may be contributing to the symptoms,” says Peter Lu, MD, pediatric gastroenterologist at Nationwide Children’s, research director of the GI Motility Center and associate professor of Pediatrics at The Ohio State University College of Medicine. “Recognizing rumination syndrome earlier may help patients access effective treatments sooner and potentially improve outcomes.”

According to the authors, this is the first study to systematically investigate the relationship between EoE and RS in children. The results also raise new questions about whether one condition may predispose patients to develop the other; an area the researchers say warrants further investigation.

References

Yang, D, Lu, PL, Khoo JS, Sanchez RE, Venkatesh RD, Russo JM, Bali N, Vaz K, Yacob D, Di Lorenzo C, Kroon Van Diest AM. Rumination syndrome and eosinophilic esophagitis in children: Defining the relationship. Journal of Pediatric Gastroenterology and Nutrition. Published online May 2026.

Image credit: Adobe Stock

 

 

About the author

Senior Strategist, Research Communications | Website

Madison Storm is the Senior Strategist of Research Communications at Nationwide Children's Hospital. She earned her bachelor's in multimedia journalism from Virginia Tech in 2021 and went on to achieve her master's in health communication from Johns Hopkins University in 2023. Her passion for transforming the complex to clear is supported by various experiences writing for consumer audiences.

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